- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $7,943.28 / $14,454.40
| Facility | | $1,862.09 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,000.00 / $5,248.07
| Professional | | $851.14 | $1,000.00 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $10,232.93 / $13,182.57 / $25,703.96
| Facility | | $10,232.93 | $13,182.57 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $831.76 / $1,380.38 / $1,862.09
| Professional | | $831.76 | $1,380.38 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,071.52 / $2,137.96 / $2,818.38
| Professional | | $1,071.52 | $2,137.96 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $1,949.84 / $11,481.54
| Facility | | $851.14 | $1,949.84 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,862.09 / $7,079.46
| Professional | | $1,122.02 | $1,862.09 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,238.72 / $3,090.30
| Professional | | $2,137.96 | $2,238.72 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $2,041.74 / $2,041.74
| Professional | | $2,041.74 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.91 / $1,949.84 / $2,511.89
| Professional | | $8.91 | $1,949.84 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $4,466.84 / $8,128.31
| Facility | | $3,235.94 | $4,466.84 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,174.90 / $1,698.24 / $2,290.87
| Professional | | $1,174.90 | $1,698.24 | $2,290.87 |